“We need to talk about substance use disorder like the disease that it is,” health educator Aly McKnight told a captive audience of thirty or so in the basement of Nashua Public Library last month. She pointed to a list of “stigmatizing” words projected onto a screen. “Alcoholic,” “junkie,” even “addiction” should be avoided, it said.

Residents had come to the Department of Public Health event to learn how to save someone from an overdose by administering the reversal drug Narcan. Each would receive a free package of the drug at the end of the night.

But first, there would be a vocabulary lesson. Instead of “addiction,” or “substance abuse,” McKnight said, try “substance use disorder.” Instead of “addict,” or “alcoholic,” say “person with a substance use disorder.”

The initial push to change the language around addiction was specifically geared toward federal agencies and medical practitioners. Obama White House Drug Czar, Michael Botticelli sent a memo outlining recommendations to federal agencies, and co-authored an article containing similar recommendations in the Journal of the American Medical Association.

Aly McKnight at the Nashua Public Library. Photo by Emily Corwin.

Botticelli’s recommendations referred to research, including a randomized study from the Center for Addiction Medicine at Massachusetts General Hospital. That study compared two sets of mental health providers. One received a survey referring to patients as "substance abusers." The other set got the same survey, except it referred to people “with substance use disorder.” The health providers, it turned out, were more likely to recommend punitive measures like jail time to the “abusers,” and more likely to recommend medical treatment to the people with a “disorder.”

Different labels lead to different outcomes.

But what about that old tenet of recovery - that you have to own your addiction with statements like “Hi I’m Sarah, I’m an addict in recovery”?

This is how Sarah Longval likes to introduce herself at recovery group meetings. I met with her and three other women at an addiction recovery center in Concord. Dawn Torregrossa was sitting next to her, and said coming to terms with the phrase “I am an addict” helped her seek help. “That denial can last for a really long time," said Torregrossa. "It’s when that light bulb goes on and you say ‘I am an addict, and I have a serious problem...A lot of people have to hit rock bottom before they come to those terms.”

Those advocating for a new addiction vocabulary make it clear that people in recovery should use whatever words they choose to describe themselves.

Still, Torregrossa seemed to indicate that something useful might get lost in a vocabulary overhaul.

Dawn Torregrossa volunteers at Hope For New Hampshire Recovery in Concord, NH. Photo by Emily Corwin.

Michael Botticelli, from the Obama administration, has thought about this. “I’ve been a member of a twelve step organization for a long time,” he said over the phone. He, too, is in recovery.

Still, Botticelli said that iconic “I am an addict,” admission is only useful when the medical community has fallen down on their job. “We can do a better job at intervening with people before they have to hit rock bottom,” he said.

His point was, doctors don’t wait for someone with heart disease to have a heart attack before they prescribe statins. They also wouldn’t wait for a diabetes patient to confess “I am a diabetic,” before prescribing insulin. Why do that with people who have substance use disorder? It’s a question for medical professionals. And, perhaps, for the rest of us, too.

A handout provided by Nashua's Department of Public Health and Community Services